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Original Investigation
October 2017

Association of Neighborhood Demographics With Out-of-Hospital Cardiac Arrest Treatment and OutcomesWhere You Live May Matter

Author Affiliations
  • 1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
  • 2University of Washington, Seattle
  • 3Rescu, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  • 4Medical College of Wisconsin, Milwaukee
  • 5Alfred and Western Hospital, Baker IDI Heart and Diabetes Institute, Monash University, Melbourne, Victoria, Australia
  • 6University of California, San Diego Health System, San Diego
  • 7University of Alabama at Birmingham
  • 8Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 9Oregon Health and Science University, Portland
JAMA Cardiol. 2017;2(10):1110-1118. doi:10.1001/jamacardio.2017.2671
Key Points

Question  Is the racial composition of neighborhoods associated with bystander treatments, emergency medical services processes of care, and survival to hospital discharge after out-of-hospital cardiac arrest?

Findings  In this cohort study of 22 816 patients with out-of-hospital cardiac arrests across 2543 census tracts between 2008 and 2011, we found that out-of-hospital cardiac arrests occurring in mixed to majority black neighborhoods had lower survival to discharge compared with neighborhoods composed of less than 25% black residents.

Meaning  Directing attention toward improving education and treatment of cardiac arrest in predominantly black neighborhoods may save lives.


Importance  We examined whether resuscitation care and outcomes vary by the racial composition of the neighborhood where out-of-hospital cardiac arrests (OHCAs) occur.

Objective  To evaluate the association between bystander treatments (cardiopulmonary resuscitation and automatic external defibrillation) and timing of emergency medical services personnel on OHCA outcomes according to the racial composition of the neighborhood where the OHCA event occurred.

Design, Setting, and Participants  This retrospective observational cohort study examined patients with OHCA from January 1, 2008, to December 31, 2011, using data from the Resuscitation Outcomes Consortium. Neighborhoods where OHCA occurred were classified by census tract, based on percentage of black residents: less than 25%, 25% to 50%, 51% to 75%, or more than 75%. Multilevel mixed-effects logistic regression modeling examined the association between racial composition of neighborhoods and OHCA survival, adjusting for patient, neighborhood, and treatment characteristics.

Main Outcomes and Measures  Survival to discharge, return of spontaneous circulation on emergency department arrival, and favorable neurologic status at discharge.

Results  We examined 22 816 adult patients with nontraumatic OHCA at Resuscitation Outcomes Consortium sites in the United States. The median age of patients with OHCA was 64 years (interquartile range [IQR], 51-78). Compared with patients who experienced OHCA in neighborhoods with a lower proportion of black residents, those in neighborhoods with more than 75% black residents were slightly younger, were more frequently women, had lower rates of initial shockable rhythm, and less frequently experienced OHCA in a public location. The percentage of patients with OHCA receiving bystander cardiopulmonary resuscitation or a lay automatic external defibrillation was inversely associated with the percentage of black residents in neighborhoods. Compared with OHCA in predominantly white neighborhoods (<25% black), those with OHCA in mixed to majority black neighborhoods had lower adjusted survival rates to hospital discharge (25%-50% black: odds ratio, 0.76; 95% CI, 0.61-0.93; 51%-75% black: odds ratio, 0.67; 95% CI, 0.49-0.90; >75% black: odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). There was similar mortality risk for black and white patients with OHCA in each neighborhood racial quantile. When the primary model included geographic site, there was an attenuated nonsignificant association between racial composition in a neighborhood and survival.

Conclusions and Relevance  Those with OHCA in predominantly black neighborhoods had the lowest rates of bystander cardiopulmonary resuscitation and automatic external defibrillation use and significantly lower likelihood for survival compared with predominantly white neighborhoods. Improving bystander treatments in these neighborhoods may improve cardiac arrest survival.